Provider Demographics
NPI:1043582927
Name:MID HUDSON ACUPUNCTURE PC
Entity type:Organization
Organization Name:MID HUDSON ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RJ
Authorized Official - Middle Name:
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURE
Authorized Official - Phone:845-343-1019
Mailing Address - Street 1:201 DOLSON AVE STE I300
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6572
Mailing Address - Country:US
Mailing Address - Phone:845-343-1019
Mailing Address - Fax:
Practice Address - Street 1:201 DOLSON AVE STE I300
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6572
Practice Address - Country:US
Practice Address - Phone:845-343-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003417-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty